Atrioesophageal Fistula Following Radiofrequency Catheter Ablation of Atrial Fibrillation.
Publication/Presentation Date
1-1-2017
Abstract
Atrioesophageal fistula (AEF) is a rare but catastrophic complication of catheter ablation of atrial fibrillation (AF), with an incidence of 0.03% to 1.5% per year. We report two cases and review the epidemiology, clinical features, pathogenesis, and management of AEF after AF ablation. The principal clinical features of AEF include fever, hematemesis, and neurologic deficits within 2 months after ablation. The close proximity of the esophagus to the posterior left atrial wall is considered responsible for esophageal injury during ablation and the eventual development of AEF. Prophylactic proton pump inhibitors, esophageal temperature monitoring, visualization of the esophagus during catheter ablation, esophageal protection devices, esophageal cooling, and avoidance of energy delivery in close proximity to the esophagus are some techniques to prevent esophageal injury. Eliminating esophageal injury during AF ablation is of utmost importance in preventing AEF. A high index of suspicion and early intervention are necessary to prevent fatal outcomes. Early surgical repair is the mainstay of treatment.
Volume
18
Issue
3
First Page
115
Last Page
122
ISSN
1530-6550
Published In/Presented At
Orosey, M., Garg, L., Agrawal, S., John, J. J., Haines, D. E., & Wong, W. S. (2017). Atrioesophageal Fistula Following Radiofrequency Catheter Ablation of Atrial Fibrillation. Reviews in cardiovascular medicine, 18(3), 115–122. https://doi.org/10.3909/ricm0883
Disciplines
Medicine and Health Sciences
PubMedID
29111544
Department(s)
Cardiology Division, Department of Medicine
Document Type
Article